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Insurance Information

If you are looking into rehabilitation for yourself or a loved one with a drug/alcohol problem, you may be wondering: will health insurance cover treatment? The cost of treatment is always a top concern, and unfortunately it prevents too many people from getting the help they need.

Health Insurance & Treatment

The unfortunate thing about insurance is that many people find it difficult to understand and navigate through. But don’t let this prevent you from getting the help you so desperately need. You may be eligible for treatment through or outside of your provider, and substance abuse treatment may even be part of your coverage without you knowing about it!

The Mental Health Parity and Addiction Equity Act

Until the Mental Health Parity Act (MHPA) of 1996, access to mental health (including addiction) treatment was extremely limited because healthcare providers were not required to cover it. The Act mandated that benefits for mental health be equal to any other coverage, but most insurers circumvented these requirements through deductibles and out-of-pocket expenses.

In 2008, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA) remedied these loopholes by requiring both insurers and group plans to mental health benefits equally to surgical and medical benefits with regard to:

  • Co-pays
  • Deductibles
  • Out-of-pocket maximums
  • Limitations on all benefits

What You Should Know About the MHPAEA

  • Only applies to plans of employers with 50+ employees
  • Requires parity for both annual limits and lifetime benefits
  • Includes out-of-network benefits
  • ONLY APPLIES TO INSURERS WHO OFFER BOTH:
    1. Medical & Surgical Benefits
    2. Mental Health & Substance Abuse Treatment Benefits

The Patient Protection & Affordable Care Act

The Patient Protection and Affordable Care Act (the “ACA,” commonly referred to as “Obamacare”) went into effect in 2010. In 2014, its government Health Insurance Exchange launched, stipulating that plans sold on the exchange include 10 essential benefits The category of “Mental Health and Substance Use Disorders” is one of those ten, which means any plan obtained through the exchange must offer benefits in this area.

What You Should Know About the ACA

  • The ACA also expands Medicaid eligibility, giving low-income addicts more access to treatment
  • ONLY APPLIES TO THESE HEALTHCARE PLANS:
    1. Plans sold on the healthcare exchange
    2. Medicaid plans
  • DOES NOT stipulate the length of treatment, only that the aforementioned plans must provide it — most of these plans will only cover residential treatment for 30 days

Options Outside of Insurance

Many people may be surprised to learn that addiction treatment is part of their benefits. It is always worthwhile to do your homework and know the facts — insurance almost never wants to pay for treatment, but don’t accept NO for an answer if you can!

Unfortunately, there are still those who cannot access treatment, even with the help that the MHPAEA and ACA provide. Outside of insurance, you may still have options for getting treatment and recovering from addiction. Explore some of these alternatives:

  • Sliding Scales – Many treatment centers offer sliding scales for lower-income patients, basing your out-of-pocket cost on your income.
  • Scholarships/Subsidies – Believe it or not, some will actually offer to “scholarship” (subsidize) part or all of your stay.
  • Non-Profits – Non-profit organizations are another avenue to explore. Religious groups run their own cost-free rehabilitation programs all across the country.
  • State-Run Treatment – There are also free or low-cost facilities run by the federal, state or local governments. They are especially widespread in areas where addiction is a major public health problem.
  • Financing – Finally, there are financing options available in the form of debt, credit, etc.
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